“Embarrassing Bodies” – the male doctor/female patient encounter

This post is based on a paper given at the “Embarrassing Bodies” conference, organised by Birkbeck, University of London

In 1858, Dr Edward Lane – owner of the Moor Park hydropathic establishment in Surrey – was named as co-respondent in one of the first divorce cases to be heard under the Matrimonial Causes Act. Henry Robinson, a civil engineer, alleged that the married Lane had committed adultery with his wife, Isabella, while she was staying at Moor Park as both a friend of the family and a patient. The events may be familiar to some as they form the subject of Kate Summerscale’s Mrs Robinson’s Disgrace (2012). Ultimately, the case rested on whether Isabella’s diary – which detailed apparently erotic encounters between her and Lane – was admissible as evidence (as the prosecution claimed) or discredited as the product of a delusional mind (the argument put forward by her defence). When Lane was dismissed as a co-respondent and brought back as a witness, he denied that anything untoward had taken place.

Widely reported in the national press, the case also attracted the attention of medical journals. Their interest was not simply that the man implicated was one of their own; the trial tapped into broader anxieties about the difficulties faced by practitioners in the course of their work. As it unfolded, there emerged key questions about the male doctor’s access to, and intimacy with, his female patients. The British Medical Journal branded the case “an extraordinary example of the dangers to which medical men above all others are exposed”. Deeming Lane “perfectly innocent”, it suggested the public would probably acquit him, but that the prospects of his establishment were likely to be harmed nonetheless.[1] In this editorial, medical men are represented as vulnerable to suspicion and innuendo is seen as having a potentially detrimental effect on their practice.

Interactions between male doctors and their female patients were often represented as sources of anxiety in Victorian medical writing. Professional journals and advice literature advised male practitioners how to guard against difficulties that may arise from examining or treating women. In an 1885 article entitled “The Relation of Medical Men to their Patients”, the Midland Medical Miscellany recommends that “[c]onfidential relations with ladies of a household” are “not only to be avoided, but to be absolutely declined” and that “examinations of female patients should always be made in the presence of a third person”.[2] Similar sentiments are espoused in Jukes de Styrap’s The Young Practitioner (1890), an advice manual for prospective medical men. It suggests readers should be “extremely cautious [….] in having married women or young females to consult you secretly – especially, if it be for vaginal, or other private examination”.[3] In cases where one needed to anaesthetise a female patient, he recommends having another practitioner present. Then, if the woman experienced “hallucinations in regard to improper language or action”, the doctor could “avoid scandal”.[4]

There was anxiety that the practitioner might fall prey to local gossip or even accusations of impropriety from family members. In 1887, the Provincial Medical Journal (the new incarnation of the Miscellany) ran an article entitled “Doctors and Lady Patients”, which explicitly engages with the problem of medical men being “made co-respondents in divorce cases”. While acknowledging such instances are rare, the article suggests they bring not only the individual, but also the wider profession into disrepute: “[s]uspicion is excited, and the confidential relations with our patients are disturbed”. To protect themselves, practitioners are warned against being too “attentive” towards female patients, for “medical men are closely watched by their clients”. [5]

Popular fiction at this time explored the way in which the young practitioner (particularly in the countryside or provinces) may become implicated in local love affairs, real or imagined. In Elizabeth Gaskell’s Mr Harrison’s Confessions (1851) the eponymous young doctor learns – much to his dismay – that his name has become attached to several women in Duncombe, earning him a reputation as a “gay Lothario”.[6] A darker instance of the doctor’s relations with women appears in Thomas Hardy’s The Woodlanders (1887). Dr Fitzpiers’s profession is shown to afford him both opportunities for infidelity and a ready alibi. When his fiancée spies his lover, Suke Damson, leaving his rooms early one morning, he convinces her she was simply an anonymous patient.[7]Intimacy between medical men and the young women of their acquaintance was not always problematised in fiction, however. The young country doctor repeatedly figures as the romantic hero, though he is rarely shown treating the object of his affections during their courtship.

As well as being associated with flirtation or adultery, even more serious allegations of abuse and misconduct could emerge from male attendance on women. In 1887, the British Gynaecological Journal featured a lengthy paper by C.H.F. Routh detailing cases of nymphomania in which women make “false charges” against their doctors. It presents the problem as systemic, noting “we are all prone, however innocent, to have such charges invented against us”. It interrogates how practitioners must “comport themselves” during encounters and, once again, discusses introducing a witness. The report’s chief concern is how men of “unimpeachable honour” can have their reputations ruined – it does not consider the possibility that the women might be telling the truth.[8] In articles such as this, it seems as though the medical press might have closed ranks to protect its own.

Where the evidence against them appeared irrefutable, however, the medical press did attack practitioners’ conduct. In 1858, the Lancet reported on “A Painful Scandal” concerning a Walthamstow-based surgeon called Richard Pilching. He had been found making written proposals of “the most filthy immorality” to a 13-year-old girl. The journal sought to distance him from the profession, arguing he had “mistaken his vocation”, and calling for him to be expelled by the General Medical Council (GMC). It cast him as a depraved predator, suggesting “his disgusting conduct” was “characteristic of the lowest and most vicious order of mind”.[9] By portraying Pilching as an aberration, the Lancet sought to uphold the image of the profession as one which was essentially honourable.[10] In my research, the journals’ engagement with improper or abusive conduct seems rare; instead interactions with female patients were more often conceived as potentially awkward or problematic.

The notion that male doctors or female patients might be embarrassed by medical encounters was a powerful argument in the hands of the medical-woman movement, which emerged from about the 1860s onwards. Aspiring female doctors and their supporters suggested that female patients would prefer practitioners of their own sex, since their modesty and delicacy would cause them to shrink from male attendance. In her essay “Medicine as a Profession for Women” (1869), Sophia Jex-Blake argues that “the unwillingness of very many girls on the verge of womanhood, to consult a medical man” causes “an enormous amount of preventable suffering”, and suggests some “ladies have habitually gone through one confinement after another without proper attendance, because the idea of employing a man was so extremely repugnant to them”.[11] She implies that male attendance is objectionable both for young women and their worldlier counterparts.

In response, some among the established profession argued for the essential purity and propriety of the male doctor-female patient relationship. In a debate about the admission of women to the profession held at the GMC in 1875, Andrew Wood – an Edinburgh-based surgeon – denied that female patients would prefer female attendance. “I have never found that women shrink from telling their ailments to me,” he insisted. In contrast, other Council members acknowledged the desirability of female practitioners. Dr Allen Thomson (representing the Universities of Glasgow and St Andrews) conceded that it was “incontrovertible that attendance on females by females is upon the whole more decent and appropriate”.[12]

The medical-woman movement capitalised on anxieties about male attendance, though it was careful to avoid impugning medical men’s conduct. Jex-Blake, for example, acknowledges “the honour and delicacy of feeling habitually shown by the gentlemen of the medical profession”. She emphasises that difficulties which may be of “no importance from [the practitioner’s] scientific standpoint” may be “very formidable indeed to the far more sensitive and delicately organized feelings of his patient”.[13] This demonstrates the way in which aspiring female practitioners deployed arguments around patient preference. However, as we have seen, even medical men adopting a “scientific standpoint” were often anxious about their attendance on women.

When discussing the role of embarrassment in the doctor-patient encounter, one usually thinks of patients demonstrating self-consciousness about their own bodies. While the female patient’s possible discomfiture was often recognised, Victorian medical discourse repeatedly grappled with the idea that the male doctor’s body might be a potential source of embarrassment or awkwardness as well. It was his contact with the woman – in private interviews or examinations – that needed to be negotiated. It was his physical presence which could be perceived as intruding upon the female patient’s body, intimate secrets, and private space. In order to protect his reputation, it was his actions that needed to be regulated.

The medical man’s presence was imagined as awkward but rarely as improper; while alert to the potential difficulties or dangers in treating women, medical commentators suggested that these could be contained or erased.

Such rhetoric was vital in order to sustain an image of the profession as honourable and gentlemanly. During this period, medicine (particularly the emerging field of general practice, which I have foregrounded here) was still divesting itself of its old associations with trade.[14] Whether medical discourse suggested female patients should be treated by medical men or women, an overriding concern was how practice could be rendered more respectable and genteel, more palatable to patients. Ultimately, attempts to navigate the embarrassment at the heart of the male doctor-female patient encounter reveal much about the professional anxieties of practitioners in this period.

[8] C.H.F Routh, “On the Etiology and Diagnosis, considered specially from a Medico-legal Point of View, of those Cases of Nymphomania which lead Women to make False Charges against their Medical Attendants”, British Gynaecological Journal, 11 (February 1887), pp. 485-511 (p. 487; 498; 501).

[10] In a subsequent issue, however, the Lancet published a letter from the surgeon’s solicitors which asked them to withhold any further commentary on the matter while legal action was pending. “Correspondence: A Painful Scandal”, Lancet, 12 March 1859, p. 278.

[11] Sophia Jex-Blake, “Medicine as a Profession for Women”, in Woman’s Work and Woman’s Culture: A Series of Essays, ed. by Josephine Butler (London: Macmillan, 1869), pp. 78-120, (p. 106; 101).

[14] See, for example, Anne Digby, Making a Medical Living: Doctors and patients in the English market for medicine, 1720-1911 (Cambridge: Cambridge University Press, 1994), p. 6.

Alison Moulds is a second-year DPhil English Literature student at St Anne’s College, University of Oxford. Working as part of the AHRC-funded project “Constructing Scientific Communities”, she is researching the construction of the doctor-patient relationship and the formation of professional identity in nineteenth-century medical writing, including fiction by doctors. She previously undertook her MA Victorian Studies part-time at Birkbeck College, University of London while working full-time in health policy and public affairs. She is Peer Review Editor for the Victorian Network journal.